Lebreton Marine, Esposito Laure, Mengelle Catherine, Del Bello Arnaud, Delarche Antoine, Dörr Gaëlle, Milongo David, Marion Olivier, Izopet Jacques, Kamar Nassim
Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
Laboratory of Virology, CHU Purpan, Toulouse, France.
J Clin Virol. 2016 Jun;79:61-67. doi: 10.1016/j.jcv.2016.04.004. Epub 2016 Apr 12.
In vitro and retrospective studies of kidney-transplant patients have shown that quinolones can efficiently prevent BK virus (BKV) replication. However, in a prospective study, a 3 month-course of levofloxacin did not decrease the rate of BK viruria in kidney-transplant patients treated with standard immunosuppression.
The aim of this study was to assess the effect of a 3-month course of ciprofloxacin prophylaxis on BKV replication in kidney-transplant patients that had received heavy immunosuppression (plasma exchange or immunoadsorption and rituximab) to achieve desensitization before undergoing HLA- and/or ABO-incompatible (ABOi) transplantation.
Twenty-nine patients were given ciprofloxacin (500mg/d) for 3 months, starting immediately after transplantation. The results were compared with results from a previous study where patients had received a similar immunosuppression regimen without ciprofloxacin prophylaxis (n=43). Around 60% of patients had undergone a retransplantation. After transplantation, all patients were given induction therapy, tacrolimus, mycophenolic acid and steroids. BK viruria and viremia were monitored at months 1, 3, 6 and 12 post-transplantation.
The rates of BK viruria, BK viremia, and BKV-associated nephropathy did not differ between patients who were given or not given ciprofloxacin prophylaxis. These rates were also identical when patients received quinolones at any time within the first year after transplantation compared to those that had not. The rate of bacterial infection was also similar in patients who had or had not received ciprofloxacin.
The use of quinolones seemed to not have any beneficial effect in preventing BKV replication in kidney-transplant patients receiving heavy immunosuppression.
对肾移植患者的体外及回顾性研究表明，喹诺酮类药物可有效预防BK病毒（BKV）复制。然而，在一项前瞻性研究中，接受标准免疫抑制治疗的肾移植患者使用3个月疗程的左氧氟沙星后，BK病毒尿症发生率并未降低。
本研究旨在评估接受强化免疫抑制（血浆置换或免疫吸附及利妥昔单抗）以在进行HLA和/或ABO血型不相容（ABOi）移植前实现脱敏的肾移植患者，使用3个月疗程环丙沙星预防对BKV复制的影响。
29例患者在移植后立即开始服用环丙沙星（500mg/天），疗程3个月。将结果与之前一项研究的结果进行比较，该研究中的患者接受了类似的免疫抑制方案，但未使用环丙沙星预防（n = 43）。约60%的患者接受了再次移植。移植后，所有患者均接受诱导治疗、他克莫司、霉酚酸和类固醇治疗。在移植后第1、3、6和12个月监测BK病毒尿症和病毒血症。
接受或未接受环丙沙星预防的患者之间，BK病毒尿症、BK病毒血症和BKV相关肾病的发生率没有差异。与未在移植后第一年内任何时间使用喹诺酮类药物的患者相比，使用喹诺酮类药物的患者的这些发生率也相同。接受或未接受环丙沙星的患者细菌感染率也相似。
在接受强化免疫抑制的肾移植患者中，使用喹诺酮类药物似乎对预防BKV复制没有任何有益作用。
